Abstract
Objectives. To investigate how personally knowing a deported migrant relates to past-year prescription drug misuse among US-citizen Latinos.
Methods. Between April and May 2019, a national sample (n = 3446) was recruited to complete an online survey. Multivariate and multinomial logistic regression models examined the role of (1) personally knowing a deported migrant and (2) the relationship to the deportee (e.g., family, friend) on (1) any past-year prescription drug misuse and (2) the frequency of prescription drug misuse. I limited analyses to US citizens only (n = 3282).
Results. Overall, 19% of all participants reported any past-year prescription drug misuse. Latinos who had a family member who was deported reported significantly higher odds of past-year prescription drug misuse and were exceedingly at higher risk for misusing prescription drugs 3 or more days in the past year as compared with Whites and Latinos who did not personally know a deported migrant.
Conclusions. Public health prevention strategies and deportation policies need to consider and address how the deportation of an individual will affect the health of that individual’s US-citizen family members.
Prescription drug misuse has emerged as a critical public health concern in the past decade. Prescription drugs refer to opioids (i.e., pain relievers), tranquilizers, stimulants, or sedatives and do not include over-the-counter drugs. The misuse of prescription drugs is characterized as their use without having a prescription, recreationally (i.e., “just for the feeling”), or in greater amounts, more often, or longer than prescribed. According to national estimates, in 2017, approximately 7% of the total adult US population reported past-year misuse of prescription drugs.1 This prevalence is significantly higher among young adults: 14% of those aged 18 to 25 years reported misusing prescription drugs in 2017. Importantly, this prevalence varies by race/ethnicity. Among those aged 18 to 25 years in 2017, 18% of Whites, 10% of Blacks, and 12% of Latinos reported past-year misuse of prescription drugs.1 Although Latinos tend to report less misuse of prescription drugs, other studies have documented an elevated prevalence compared with the general population. For instance, a study among Latinos in Texas border communities found that past-year prescription drug misuse ranged from 7% to 26% among Latinos, depending on gender and border community.2 Similarly, a national study among adults aged 65 years or older found that Latinos had 3 times the odds of misusing prescription drugs in the past year compared with Whites.3
Prescription drug misuse carries numerous adverse health implications. The misuse of prescription drugs can lead to the development of prescription drug dependence, increase susceptibility to alcohol and other drugs, transition into injection drug use, and increase risk of HIV and other blood-borne infections and mortality stemming from an overdose.4–8 These health consequences and implications are notably evident by the current opioid epidemic in the United States, which claimed the lives of more than 47 000 Americans through overdoses in 2017 alone.9 It is not surprising that opioids are the most commonly misused prescription drug.9,10
Furthermore, although opioid overdoses are highest among Whites, recent data have documented that opioid overdoses among Latinos are increasing at an exceedingly faster rate relative to Whites. For example, opioid overdose deaths among Latinos in Massachusetts doubled from 2014 to 2017.11 This trend has also been observed nationwide. According to data from the Centers for Disease Control and Prevention, fatalities resulting from opioid overdose increased by 53% between 2014 and 2016 among Latinos.12 However, why opioid overdose fatalities are increasing among Latinos is poorly understood.
Much research has focused on understanding factors associated with prescription drug misuse, including sociodemographic characteristics, mental and substance use disorders, social factors (e.g., social norms, peer pressure, low social support), and contextual factors (e.g., physicians’ prescribing practices).2,5,13–15 However, the role of structural-level factors and their influence on prescription drug misuse have received almost no attention. Specifically, within the context of Latinos in the United States, emerging findings from my research team have underscored the importance of deportations as a structural determinant of the substance-using behaviors of US-citizen Latinos. With use of current nationally represented data (2019), findings from this work suggest that US-citizen adult Latinos who have had a family member deported have significantly higher odds of reporting symptoms of a drug use disorder as compared with Whites.16 The present study extends this previous work and is distinct in that this study exclusively examined the relationship between the deportation of family members and prescription drug misuse among US-citizen Latinos. The deportation of a family member is a traumatic experience that has an impact on the whole family unit who experiences multiple severe emotional and psychological stressors.17–19 Such stressors may increase vulnerability to substance use, including prescription drug misuse.
Over the past decade, the United States has heightened immigration enforcement efforts and reached historic levels of deportations. Since 2008, more than 3 million migrants have been deported from the United States. Most recently available data indicate that deportations remain high: more than 256 000 migrants were deported in 2017.20 Importantly, Latino migrants make up the largest proportion of deportees. About 90% of all deported migrants are of Latino origin.20 Given the increasing deportations of Latino migrants and increasing trends in prescription drug misuse, including increasing rates of opioid addiction and misuse, in the United States make this line of research timely and significant. The present study investigates the role of US-citizen Latinos’ relationship to the deported migrant on prescription drug misuse relative to other racial/ethnic groups and among Latinos only.
METHODS
This study draws on anonymous and de-identified data from the National Social Policy Survey. The original objective of the study was to better understand how social, political, and economic factors contribute to health and racial/ethnic health disparities. Between April and May of 2019, the National Social Policy Survey study team recruited 3446 adult participants of White, Black, and Latino racial/ethnic descent via e-mail invitations to complete an online survey. Participants were recruited by using contact information (i.e., e-mail addresses) from the national voter registration database and Web panels from Pure Spectrum and Cint, 2 market research firms. Briefly, Web panels entail registries of individuals who have agreed to partake in online surveys. Web panels are constructed through targeted invitations that are meant to reflect the general population. Web panels were used to reach nonregistered voters, including non–US citizens, to reduce bias. Next, participants were randomly selected and invited to participate via e-mail. While participants were recruited from different sources and sample vendors, they were collected simultaneously and deposited into a single uniform data set. A total of 6355 potential participants were invited via e-mail to complete the online survey. Of these, 5734 were eligible for the study, and 3446 participants agreed to complete the survey. Participants received no financial incentives.
The final data set was weighted within each racial/ethnic group with the 2017 Census American Community Survey (ACS). Once all the data were collected, demographics characteristics were tabulated for each racial/ethnic group and compared with the ACS adult population. For each racial group, weights were added consecutively using a raking algorithm to balance the demographics to match the 2017 ACS overall adult population. The registered voter portion of the sample was derived from a different source to ensure that the respondents were registered to vote and could be verified on the voter file. Otherwise, they were randomly selected and had randomly distributed demographic characteristics much like the nonregistered portion.
Measures
The 2 dependent variables were (1) any prescription drug misuse and (2) the frequency of prescription drug misuse, in the past year. Participants were asked, “In the past 12 months on how many days did you use any prescription medications ‘recreationally’ (just for the feeling, or using more than prescribed)?” These questions were taken from the Substance Use Brief Screen scale.21 Response options were (1) never, (2) 1 or 2 days in the past 12 months, or (3) 3 or more days in the past 12 months. Any prescription drug misuse is defined as engaging in prescription drug misuse at least 1 day in the past year (vs never). Frequency of prescription drug misuse was a 3-category variable based on the original question (i.e., never, 1 or 2 days, 3 or more days).
The primary independent variable of interest was Latinos’ relationship to a deported migrant if they reported personally knowing someone who has been deported. Participants were first asked if they personally know someone who was deported. Those who answered yes were then asked to self-report if this was a family member, a friend, or a coworker or community member (participants were only allowed to choose 1 of these options and could not choose multiple answers). Using these data, I characterized participants into 6 mutually exclusive racial/ethnic groups: Whites, Blacks, Latinos who do not personally know someone who has been deported, Latinos who had a family member deported, Latinos who had a friend deported, and Latinos who had a coworker or community member deported.
Important covariates included alcohol use disorder (AUD) and psychological distress. Both of these variables have been associated with prescription drug misuse.14 AUD was measured with the Alcohol Use Disorders Identification Test-Concise (AUDIT-C), which has proven high sensitivity for detecting AUD.22 This measure includes 3 items that ask participants how often they consume alcohol (never, monthly or less, 2 to 4 times a month, 2 or 3 times a week, or 4 times or more a week), how many alcoholic drinks they consume on a typical drinking day (1 or 2 drinks, 3 or 4 drinks, 5 or 6 drinks, 7 to 9 drinks, 10 or more drinks), and how often they consume 6 or more drinks on 1 occasion (never, monthly or less, 2 to 4 times a month, 2 or 3 times a week, or 4 times or more a week). A point is attributed to each response, ranging from 0 to 4. Scores are summed with a possible range between 0 and 12 points. A score of 4 or more for men and 3 or more for women is considered a positive screening for AUD.22
The Patient Health Questionnaire (PHQ-4) was used to assess psychological distress. The PHQ-4 consists of 4 question-items that assess feelings of nervousness and anxiousness, uncontrollable worrying, disinterest or pleasure in doing things, and sentiments of depression or hopelessness. Participants self-reported the frequency of these sentiments in the past 2 weeks: not at all, several days, more than half the days, or nearly every day. A point is assigned to each response option (ranging from 0 to 3 points) and summed (total possible points: 12). A score of 3 or more is characterized as having psychological distress.23 Important sociodemographic characteristics included age, biological sex, marital status, being US-born, highest educational attainment, employment status (full- or part-time vs unemployed), annual household income, and voter registration status (yes vs no). Finally, to assess for US citizenship, participants were first asked if they were born in the United States. Participants who answered “no” were asked they were a naturalized US citizen, have applied for citizenship, were a legal permanent resident, were a visa holder, or other. Participants who reported being US-born or naturalized US citizens were characterized as being US citizens.
Statistical Analysis
I weighted all statistical analyses to adjust for the sampling methods. I conducted analyses with Stata version 15 software (StataCorp LP, College Station, TX). Given the study’s objective, I restricted all analyses to US citizens and excluded non–US citizens (n = 164). I first employed descriptive characteristics for our sample, stratifying by race/ethnicity. Next, I conducted multivariate analyses to evaluate how race/ethnicity and Latinos’ relationship to deported migrants related to each outcome variable. For the dichotomous dependent variable, any prescription drug misuse, I estimated a logistic regression model. For the categorical dependent variable, frequency of prescription drug misuse, I estimated a multinomial logistic regression model. Both models controlled for sociodemographic characteristics and covariates. Finally, I replicated these models with only the sample of US-citizen Latinos to evaluate how Latinos’ relationship to deported migrants relate to each outcome, using Latinos who do not personally know a deported migrant as the comparison group.
RESULTS
Sample characteristics stratified by race/ethnicity are presented in Table 1. Overall, half the sample was male and they were on average aged 42 years. The majority were US-born and registered voters, though Latinos were the least likely racial/ethnic group to be registered to vote. White and Black participants were significantly more likely to report not personally knowing a deported migrant than were Latinos. Overall, 39% of Latinos in our sample personally knew someone who had been deported. Among Latinos, 17% had a friend who was deported, 10% had a family member who was deported, and 12% reported knowing a coworker or community member who was deported. In regards to prescription drug misuse, 19% (n = 666) of participants reported misusing prescription drugs in the past year. A higher proportion of Latinos and Blacks reported engaging in prescription drug misuse in the past year than of Whites. Latinos were also more likely to report psychological distress as compared with Whites and Blacks.
TABLE 1—
Selected Participant Characteristics of US-Citizen Participants by Race/Ethnicity: United States, 2019
| Variable | Total (n = 3446), Weighted % (Unweighted No.) or Mean ±SD | White (n = 712), Weighted % (Unweighted No.) or Mean ±SD | Black (n = 710), Weighted % (Unweighted No.) or Mean ±SD | Latinos (n = 2024), Weighted % (Unweighted No.) or Mean ±SD | P |
| Male | 49 (1368) | 49 (405) | 47 (268) | 50 (695) | .45 |
| Mean age, y | 42 ±16.57 | 48 ±16.74 | 41 ±16.33 | 39 ±15.85 | |
| US-born | 87 (3107) | 98 (700) | 95 (691) | 80 (1716) | < .001 |
| Married | 39 (1219) | 58 (411) | 36 (252) | 50 (1537) | < .001 |
| Employed | 60 (1956) | 73 (520) | 54 (378) | 58 (1058) | < .001 |
| Educational attainment | |||||
| < high school | 9 (200) | 4 (17) | 8 (39) | 11 (144) | < .001 |
| Graduated high school | 28 (944) | 27 (193) | 25 (179) | 29 (572) | |
| Some college | 31 (1067) | 27 (195) | 35 (256) | 31 (616) | |
| Graduated college | 33 (1071) | 42 (303) | 32 (232) | 29 (536) | |
| Total family income, $ | |||||
| < 20 000 | 13 (442) | 13 (86) | 17 (116) | 13 (240) | < .001 |
| 20 000–39 999 | 24 (813) | 23 (155) | 28 (196) | 23 (462) | |
| 40 000–59 999 | 22 (714) | 19 (140) | 22 (154) | 23 (420) | |
| 60 000–79 999 | 16 (520) | 20 (144) | 14 (103) | 14 (273) | |
| 80 000–99 999 | 8 (266) | 9 (62) | 5 (38) | 9 (273) | |
| 100 000–149 999 | 8 (264) | 10 (77) | 7 (74) | 8 (137) | |
| ≥ 150 000 | 4 (141) | 5 (35) | 5 (32) | 4 (74) | |
| Registered to vote | 84 (2789) | 87 (623) | 91 (640) | 82 (1526) | < .001 |
| Relationship with deportees | < .001 | ||||
| Does not personally know a deportee | 68 (2221) | 80 (565) | 75 (529) | 61 (1127) | |
| Had a family member who was deported | 8 (283) | 3 (30) | 8 (56) | 10 (197) | |
| Had a friend who was deported | 13 (436) | 6 (50) | 10 (68) | 17 (318) | |
| Had a coworker or community member who was deported | 10 (342) | 8 (63) | 7 (53) | 12 (226) | |
| Any prescription drug misuse, past y | 19 (666) | 13 (100) | 22 (154) | 21 (412) | < .001 |
| Alcohol use disorder | 48 (1618) | 48 (345) | 48 (339) | 48 (934) | .93 |
| Psychological distress | 49 (1686) | 46 (321) | 45 (320) | 51 (1045) | .005 |
Note. Sample size n = 3446.
Multivariate Regression
Multivariate regression estimates (Table 2) show that Latinos who had a family member who was deported had more than 3 times the odds of reporting past-year prescription drug misuse than did Whites. Latinos who had a friend or a coworker or community member who was deported also reported higher odds of misusing prescription drugs than did Whites. Latinos who did not personally know a deportee and any past-year prescription drug misuse were not statistically different from Whites.
TABLE 2—
Multivariate Logistic Regression Models Examining the Relationship Between Any Past-Year Prescription Drug Misuse, Race/Ethnicity, and Knowing a Deportee: United States, 2019
| Variable | Any Past-Year Prescription Drug Misuse,a AOR (95% CI) |
| Race/ethnicity | |
| Whites (Ref) | 1 |
| Blacks | 1.56 (1.08, 2.22) |
| Latinos who do not personally know a deported migrant | 0.98 (0.68, 1.40) |
| Latinos who know a family member who was deported | 3.27 (1.88, 5.67) |
| Latinos who know a friend who was deported | 2.40 (1.58, 3.64) |
| Latinos who know a coworker or community member who was deported | 1.26 (0.77, 2.04) |
| Male | 1.02 (1.00, 1.04) |
| Age | 0.99 (0.98, 1.00) |
| US-born | 2.46 (1.25, 4.83) |
| Education | |
| < high school (Ref) | 1 |
| Graduated high school | 0.82 (0.53, 1.27) |
| Some college | 0.74 (0.48, 1.14) |
| Graduated college | 0.74 (0.47, 1.17) |
| Employed | 1.32 (1.05, 1.66) |
| Total family income, $ | |
| < 20 000 (Ref) | 1 |
| 20 000–39 999 | 0.75 (0.53, 1.07) |
| 40 000–59 999 | 0.99 (0.69, 1.40) |
| 60 000–79 999 | 0.72 (0.49, 1.07) |
| 80 000–99 999 | 0.58 (0.34, 0.98) |
| 100 000–149 999 | 0.77 (0.48, 1.26) |
| ≥ 150 000 | 1.01 (0.58, 1.74) |
| Alcohol use disorder | 3.34 (2.66, 4.19) |
| Psychological distress | 2.99 (2.37, 3.78) |
Note. AOR = adjusted odds ratio; CI = confidence interval. Sample size: unweighted n = 3282.
n = 666.
Multinomial Regression
Findings from the multinomial logistic regression models are displayed in Table 3. Model 1 results suggest that Latinos who had a family member who was deported had the greatest risk for misusing prescription drugs. Latinos who had a family member who was deported had 6.05 and 2.64 times the relative risk of misusing prescription drugs 3 or more days and 1 or 2 days in the past year, respectively, as compared with Whites. Having a friend or coworker or community member who was deported was also associated with increased frequencies of misusing prescription drugs. Associations between Latinos who did not personally know a deportee and the frequency of prescription drug misuse were nonsignificant.
TABLE 3—
Multinomial Logistic Regression Models Examining the Relationship Between the Frequency of Past-Year Prescription Drug Misuse, Race/Ethnicity, and Personally Knowing a Deported Migrant: United States, 2019
| Variable | Misused Prescription Drugs 1 or 2 Days vs None, RRR (95% CI) | Misused Prescription Drugs 3 or More Days vs None, RRR (95% CI) |
| Race/ethnicity | ||
| Whites (Ref) | 1 | 1 |
| Blacks | 1.67 (1.09, 2.57) | 1.89 (1.29, 2.76) |
| Latinos who do not personally know a deported migrant | 1.16 (0.76, 1.77) | 0.73 (0.48, 1.12) |
| Latinos who know a family member who was deported | 2.64 (1.46, 4.77) | 6.05 (3.68, 9.94) |
| Latinos who know a friend who was deported | 4.27 (2.66, 6.86) | 2.93 (1.86, 4.62) |
| Latinos who know a coworker or community member who was deported | 1.61 (0.91, 2.83) | 1.27 (0.70, 2.34) |
| Male | 1.02 (0.99, 1.05) | 1.02 (0.99, 1.04) |
| Age | 0.99 (0.98, 1.00) | 0.98 (0.97, 1.00) |
| US-born | 3.82 (1.34, 10.89) | 1.85 (0.84, 4.07) |
| Education | ||
| < high school (Ref) | 1 | 1 |
| Graduated high school | 0.77 (0.44, 1.33) | 0.87 (0.50, 1.52) |
| Some college | 0.71 (0.42, 1.22) | 0.76 (0.43, 1.34) |
| Graduated college | 0.85 (0.49, 1.47) | 0.66 (0.37, 1.20) |
| Employed | 1.40 (1.05, 1.88) | 1.25 (0.94, 1.66) |
| Total family income, $ | ||
| < 20 000 (Ref) | 1 | 1 |
| 20 000–39 999 | 0.88 (0.56, 1.37) | 0.64 (0.41, 0.99) |
| 40 000–59 999 | 0.88 (0.56, 1.40) | 1.08 (0.70, 1.66) |
| 60 000–79 999 | 0.70 (0.42, 1.18) | 0.73 (0.45, 1.20) |
| 80 000–99 999 | 0.35 (0.17, 0.74) | 0.81 (0.43, 1.52) |
| 100 000–149 999 | 0.63 (0.33, 1.22) | 0.92 (0.50, 1.68) |
| ≥ 150 000 | 0.77 (0.16, 0.97) | 1.23 (0.26, 1.69) |
| Alcohol use disorder | 3.99 (2.93, 5.44) | 2.89 (2.17, 3.86) |
| Psychological distress | 3.45 (2.50, 4.78) | 2.66 (1.97, 3.59) |
Note. CI = confidence interval; RRR = relative risk ratio. Sample size: unweighted n = 3282.
Multivariate and Multinomial Regression
Estimates for the multivariate and multinomial regression models among US-citizen Latinos only are presented in Table 4. Findings suggest that compared with Latinos who do not personally know a deported migrant (model 1), Latinos who personally know a deported migrant have higher odds of reporting past-year prescription drug misuse, regardless of their relationship to the deportee. Latinos who had a family member who was deported had the highest odds—more than 5 times the odds—of engaging in past-year prescription drug misuse relative to Latinos who did not personally know a deportee. Model 2 results suggest that Latinos who had a family member or friend who was deported are at significantly greater risk for misusing prescription drugs at higher frequencies as compared with Latinos who did not personally know a deportee. Latinos who had a family member who was deported had more than 9 times the risk of misusing prescription drugs 3 or more days as compared with Latinos who did not personally know a deportee.
TABLE 4—
Multivariate and Multinomial Logistic Regression Models Examining the Relationship Between Any Past-Year Prescription Drug Misuse and the Frequency of Misuse Among US-Citizen Latinos: 2019
| Model 1: Any Past-Year Prescription Drug Misuse, AOR (95% CI) | Model 2 |
||
| Misused Prescription Drugs 1 or 2 Days vs None, RRR (95% CI) | Misused Prescription Drugs 3 or More Days vs None, RRR (95% CI) | ||
| Relationship with deporteesa | |||
| Do not personally know a deportee (Ref) | 1 | 1 | 1 |
| Had a family member who was deported | 5.45 (3.59, 8.28) | 2.27 (1.31, 3.94) | 9.37 (5.71, 15.36) |
| Had a friend who was deported | 3.93 (2.79, 5.52) | 3.73 (2.46, 5.65) | 4.18 (2.66, 6.58) |
| Had a coworker or community member who was deported | 1.63 (1.08, 2.48) | 1.42 (0.86, 2.38) | 1.86 (1.04, 3.34) |
| Male | 1.02 (0.99, 1.05) | 1.02 (0.99, 1.06) | 1.02 (0.99, 1.05) |
| Age | 0.99 (0.98, 1.00) | 0.99 (0.97, 1.00) | 0.99 (0.98, 1.01) |
| US-born | 2.48 (1.22, 5.02) | 3.50 (1.22, 10.01) | 1.99 (0.87, 4.56) |
| Education | |||
| < high school (Ref) | 1 | 1 | 1 |
| Graduated high school | 0.90 (0.52, 1.55) | 0.96 (0.48, 1.94) | 0.84 (0.42, 1.67) |
| Some college | 0.83 (0.48, 1.43) | 0.88 (0.45, 1.73) | 0.78 (0.39, 1.58) |
| Graduated college | 0.82 (0.46, 1.44) | 1.04 (0.51, 2.09) | 0.66 (0.31, 1.39) |
| Employed | 1.33 (0.98, 1.80) | 1.38 (0.95, 2.02) | 1.28 (0.87, 1.87) |
| Total family income, $ | |||
| < 20 000 (Ref) | 1 | 1 | 1 |
| 20 000–39 999 | 0.91 (0.56, 1.48) | 0.86 (0.48, 1.56) | 0.97 (0.52, 1.82) |
| 40 000–59 999 | 1.02 (0.63, 1.64) | 0.69 (0.38, 1.24) | 1.44 (0.78, 2.67) |
| 60 000–79 999 | 0.79 (0.46, 1.35) | 0.64 (0.33, 1.27) | 0.96 (0.47, 1.95) |
| 80 000–99 999 | 0.43 (0.20, 0.93) | 0.29 (0.11, 0.76) | 0.62 (0.23, 1.66) |
| 100 000–149 999 | 0.64 (0.32, 1.28) | 0.46 (0.18, 1.15) | 0.90 (0.36, 1.21) |
| ≥ 150 000 | 0.87 (0.42, 1.79) | 0.80 (0.32, 2.00) | 0.97 (0.38, 2.43) |
| Alcohol use disorder | 3.59 (2.63, 4.90) | 4.56 (3.01, 6.90) | 2.96 (1.99, 4.42) |
| Psychological distress | 2.28 (1.67, 3.10) | 2.87 (1.87, 4.39) | 1.87 (1.27, 2.75) |
Note. AOR = adjusted odds ratio; CI = confidence interval; RRR = relative risk ratio. Sample size: n = 1868.
Latinos who did not personally know a deportee, n = 1127; Latinos who had a family member who was deported, n = 197; Latinos who had a friend who was deported, n = 318; Latinos who had a coworker or community member who was deported, n = 226.
DISCUSSION
This is the first empirical study to investigate the association between the deportation of others (i.e., family members, friends, and coworkers or community members) and prescription drug misuse among US-citizen Latinos. Using current data, this study found that 21% of US-citizen Latinos reported past-year prescription drug misuse. Startlingly, this prevalence is significantly higher than the national average and population-based studies of prescription drug misuse.1,2 However, recent studies have documented that prescription drug misuse and related consequences have been increasing at a faster rate among Latinos than Whites.12 Nonetheless, this finding merits confirmation by future research. In multivariate analyses, personally knowing a deportee was strongly associated with prescription drug misuse among US-citizen Latinos. These are novel findings and have not been previously documented in the substance abuse literature, to my knowledge. Results highlight the role of deportations as a potentially critical determinant of prescription drug misuse among US-citizen Latinos, which carries important implications for the current prescription drug misuse epidemic.
Specifically, this study showed that US-citizen Latinos who personally know a deported migrant were more likely to report misusing prescription drugs in the past year and at higher frequencies than Whites and Latinos who do not personally know a deported migrant. Alarmingly, US-citizen Latinos who had a family member who was deported were exceedingly at higher risk for prescription drug misuse and misusing at higher frequencies. In US-citizen Latino–only models, these associations were retained, but the strength of the association was much more pronounced. US-citizen Latinos who had a friend who was deported were also more likely to engage in prescription drug misuse and at higher frequencies than Whites and US-citizen Latinos who did not personally know a deportee. These findings are aligned with previous work that has linked the deportation of others, especially family members, to AUD, drug use disorders, and poor mental health outcomes among US-citizen Latinos.16,18,24,25
It is worth nothing that differences in any past-year prescription drug misuse and the frequency of misuse between US-citizen Latinos who do not personally know a deported migrant and Whites were nonsignificant. Collectively, findings suggest that US-citizen Latinos who have been affected by the deportation of a family member or friend may be at increased risk for prescription drug misuse. The deportation of family members and friends is a traumatizing experience filled with extreme emotional and psychological consequences (e.g., posttraumatic stress, fear and worry, anxiety, depressive symptoms) that extend well after the deportation of an individual.16,18,25 Research has found that individuals may turn to prescription drug misuse to cope with stress, unfair treatment (e.g., discrimination), and negative emotions.26–28 It is likely that stressors stemming from the deportation of family and friends may increase susceptibility to prescription drug misuse as a coping mechanism.
Some limitations should be considered when one is interpreting these findings. The cross-sectional study design does not allow for causal inferences between associations found among prescription drug misuse and the deportation of family and friends. Latino participants may have known more than 1 deportee (e.g., family member and friend); however, the survey did not allow for multiple response options. Though it is likely that participants based their response on their strongest relationship to the deportee (i.e., those who had both a friend and a family member who were deported chose “family member” as their response), we cannot be certain. This is an important limitation given that studies have also found that Latinos with greater number of deportees in their social networks may experience worse health.24 Future studies should consider a longitudinal study design to determine if the deportations of others are influencing the substance-using behaviors of US-citizen Latinos.
Furthermore, given that the original data set was not designed with the purpose to investigate drug use or mental health, data on the types of prescription drugs that were being misused, reasons for misusing them, and previous history of a mental health or drug use disorder past a 1-year mark, or information on a previous drug overdose were not collected, which would have provided important contextual information. Future studies should explore the relationship between deportations and prescription drug misuse in greater depth.
Lastly, because of the sensitive nature of deportations and substance use, our findings are subject to underreporting bias. However, the survey was completely anonymous and self-administered online, which likely increased feelings of anonymity and reduced social desirability bias. Notwithstanding these limitations, this well-powered and current data set allowed for a comparative analysis of a significantly timely issue that can be used to inform policies and prevention strategies.
As public health and policy officials continue addressing the prescription drug misuse epidemic, it is critical to consider how immigration enforcement policies may influence this epidemic. Findings from this study, along with the findings from the existing literature, suggest that immigration enforcement policies may be indirectly creating stressful environments for Latinos, regardless of citizenship, and shaping their substance-using behaviors. However, how the deportation of an individual will affect his or her family is rarely considered when migrants are facing deportation. This is extremely concerning given that US-citizen Latinos are closely connected to their migrant counterparts. Continued high rates of deportations have the potential to exacerbate the prescription drug misuse epidemic in the United States. There is an urgent need for immigration enforcement policies to consider how deportations may affect the health of US-citizen Latinos. Furthermore, tailored interventions for Latinos that address specific stressors stemming from the deportation of family members are needed to curb substance use, prescription drug misuse, and the progression into dependence.
ACKNOWLEDGMENTS
This work was supported in part by the National Institute on Alcohol Abuse and Alcoholism (R01AA027767).
Note. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.
CONFLICTS OF INTEREST
The author has no conflict of interest.
HUMAN PARTICIPANT PROTECTION
The study protocol was approved by the institutional review board of the University of New Mexico. The present analysis is based on de-identified data and, therefore, the institutional review board of University of Texas Austin required no review or oversight.
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